2A-2.017. Forms  


Effective on Wednesday, December 11, 2019
  • 1The Following Bureau of Victim Compensation forms can be obtained at www.myfloridalegal.com or by contacting the Office of the Attorney General, Bureau of Victim Compensation, PL-01 The Capitol, Tallahassee, FL 32399, (850)414-3300:

    33(1) Any person desiring to apply for Victim Compensation, Property Loss or relocation benefits shall submit a completed form BVC100, Bureau of Victim Compensation Claim Form revised (11/19), adopted and incorporated by reference, 66https://www.flrules.org/Gateway/reference.asp?No=Ref-1132468.

    69(2) Any person applying for domestic violence relocation shall submit, via a certified domestic violence center, a completed form BVC106DV Domestic Violence Relocation Certification Worksheet revised (11/19), adopted and incorporated by reference, 101https://www.flrules.org/Gateway/reference.asp?No=Ref-11327103. This certification must be obtained from and completed by a certified domestic violence center representative that has been designated by the Office of the Attorney General to assist in the certification process.

    136(3) Any person applying for sexual battery relocation shall submit, via a certified rape crisis center, a completed form BVC106RS, Sexual Battery Relocation Certification Worksheet revised (11/19), adopted and incorporated by reference, 168https://www.flrules.org/Gateway/reference.asp?No=Ref-11329170. This certification must be obtained from and completed by a certified rape crisis center representative that has been designated by the Office of the Attorney General to assist in the certification process.

    203(4) Any person applying for human trafficking relocation shall submit, via a certified rape crisis or domestic violence center or state attorney, or statewide or federal prosecutor, a completed form BVC106HT, Human Trafficking Relocation Certification Worksheet revised (11/19), adopted and incorporated by reference, 246https://www.flrules.org/Gateway/reference.asp?No=Ref-11328248. This certification must be obtained from and completed by a certified domestic violence or rape crisis center representative that has been designated by the Office of the Attorney General to assist in the certification process or a state attorney, or statewide or federal prosecutor.

    293(5) Any person receiving domestic violence relocation funds must submit, via a certified domestic violence center, form BVC421DV Notification of Possible Recoupment and/or Prosecution for Fraud revised (4/19), adopted and incorporated by reference, 326https://www.flrules.org/Gateway/reference.asp?No=Ref-10376328.

    329(6) Any person receiving sexual battery relocation funds must submit, via a certified rape crisis center, form BVC421RS Notification of Possible Recoupment and/or Prosecution for Fraud revised (4/19), adopted and incorporated by reference, 362https://www.flrules.org/Gateway/reference.asp?No=Ref-10380364.

    365(7) Any person receiving human trafficking relocation funds must submit, via a certified rape crisis or domestic violence center, state attorney, statewide or federal prosecutor, form BVC421HT Notification of Possible Recoupment and/or Prosecution for Fraud revised (4/19), adopted and incorporated by reference, 407https://www.flrules.org/Gateway/reference.asp?No=Ref-10378409.

    410(8) In lieu of providing the documents listed in subsection 4202A-2.002(7), 421F.A.C., any person applying for disability compensation may submit a completed form BVC409 Victim Compensation Treatment Disability Statement revised (10/15), adopted and incorporated by reference, 446https://www.flrules.org/Gateway/reference.asp?No=Ref-06424448.

    449(9) In lieu of a law enforcement reporting form or similar document from a proper authority that establishes a compensable crime occurred, a form BVC430 Law Enforcement Information Reporting Form revised (11/19), adopted and incorporated by reference, 486https://www.flrules.org/Gateway/reference.asp?No=Ref-11330 488may be used. The form must be submitted by the Bureau of Victim Compensation directly to the appropriate law enforcement agency to be considered.

    512(10) In lieu of submitting a written explanation, any person desiring to submit an application for benefits more than 1 year, but less than 2 years, from the date of the crime, for crimes occurring before October 1, 2019, or for benefits more than 3 years but less than 5 years from the date of crime for crimes occurring on or after October 1, 2019, may submit form BVC102 Filing Time Explanation Form revised (11/19), adopted and incorporated by reference, 592https://www.flrules.org/Gateway/reference.asp?No=Ref-11325594.

    595(11) In lieu of submitting a written explanation, any person applying for benefits who reported the crime more than 72 hours for crimes occurring before October 1, 2019, or more than 120 hours for crimes occurring on or after October 1, 2019, from the date of the discovery of the crime, may submit form BVC103 Reporting Time Explanation Form revised (11/19), adopted and incorporated by reference, 661https://www.flrules.org/Gateway/reference.asp?No=Ref-11326663.

    664(12) In lieu of submitting a written explanation, any person applying for benefits who has been determined pursuant to paragraph 6842A-2.002(4)(b), 685F.A.C. to be non-cooperative, may submit form BVC104 Non Cooperation Explanation Form revised (10/15), adopted and incorporated by reference, 704https://www.flrules.org/Gateway/reference.asp?No=Ref-06428706.

    707(13) In lieu of providing the documents listed in subsection 7172A-2.002(6), 718F.A.C., any person applying for property loss benefits may submit form BVC410 Property Loss Disability Verification Form revised (10/15), adopted and incorporated by reference, 742https://www.flrules.org/Gateway/reference.asp?No=Ref-06429744.

    745(14) In lieu of providing the documents listed in subsection 7552A-2.002(6), 756F.A.C., any person applying for wage loss benefits may submit form BVC405 Victim Compensation Wage Loss Employment Report (10/15), adopted and incorporated by reference, 780https://www.flrules.org/Gateway/reference.asp?No=Ref-06430782.

    783(15) Any person desiring to apply for Emergency Responder Death Benefits shall submit a completed form BVC100ER, Emergency Responder Death Benefit Claim Form revised (06/17), adopted and incorporated by reference, 813http://www.flrules.org/Gateway/reference.asp?No=Ref-08767815.

    816Rulemaking Authority 818960.045(1) FS. 820Law Implemented 822960.03, 823960.05, 824960.065, 825960.07, 826960.12, 827960.13(5)(a), 828960.15, 829960.16, 830960.17, 831960.18, 832960.195, 833960.196, 834960.198, 835960.198369 FS. History‒New 2-11-16, Amended 10-29-17, 5-20-19, 12-11-19.